By Virginia M. DeRoma, Ph.D. and Dan P. Evatt, Ph.D.
May. 14, 2025

iStock photo by Seth Love

Making a day of it at the track, buying a scratch-off or lotto ticket at the gas station, poker night with friends, sports betting on your phone while you stream a movie, playing roulette at the casino… at first glance, these seem like harmless recreational activities that might be common in your social circle. However, some recreational gamblers, including service members, will develop problematic gambling patterns, and a percentage of those with at-risk or problematic gambling patterns will further progress to gambling addiction.¹

Maladaptive gambling behaviors, generally referred to as “problematic gambling,” can be viewed as occurring along a continuum, ranging from subclinical (i.e., low, moderate, and at-risk problematic gambling) to clinically significant conditions (e.g., gambling disorder; addictive behaviors).² In fact, the wide range of labels and definitions for problematic gambling in the research literature has made pinpointing prevalence rates of gambling problems difficult.³Gambling disorder, a pattern of repeated and ongoing wagering that interferes with a person’s daily life, has the advantage of being operationalized by its Diagnostic and Statistical Manual of Mental Disorders (5^th ed.; DSM-5) classification.⁴

The emergence of mobile gambling has brought new challenges in addressing problematic gambling. Online gambling offers immediate access to virtually all gambling forms (or types) via our inescapable (or universal) smart phones, with at-your-finger tips access and multiple forms of currency accepted.⁵ More research is needed to determine if expanded gambling access via mobile gambling increases risk for problematic gambling due to a reduction in barriers to access.

Previous research has found that service member proximity to gambling opportunities increases risk for gambling disorders.⁶ While some research found active-duty service members and veteran populations have an elevated risk of gambling disorder when compared to the general population⁷, other research found similar rates in military and civilian samples. Gambling disorder is estimated to affect 6.6 per 100,000 service members, with active-duty service members gambling significantly more than veterans and civilians.^6,7,8 Frequency rates of gambling reported by military members in a National Guard sample indicated 18% gambled once per week and 44% gambled four or more times per week. Further, active-duty service members were found to be significantly more likely to prefer (60% vs. 9% of veterans and civilians) and engage in (74.19% vs. 20.62% veterans and 24.9% civilians) online gambling.⁷

Gambling rates have further been examined in context of military-specific stressors. Rates of gambling problems after deployment, relative to other mental health conditions and concerns, suggest gambling may be used as an escape strategy to manage readjustment distress.² Post-deployment rates of gambling problems were found to be below rates of PTSD detected, but higher than depression and/or alcohol problems involving either harmful drinking or dependence. Problematic gambling detected was associated with specific readjustment difficulties, including not wanting to talk about deployment with family/friends, more arguments with intimate partners, and difficulties resuming routine social activities.

Efforts to reach service members with problematic gambling intensified following the Gambling Addiction Prevention Act of 2018.⁹ This act, which followed prior Government Accountability Office recommendations for gambling disorder screening through service member health assessments, required the Department Of Defense to develop policies and programs  to support education, prevention, and treatment of gambling disorder.¹⁰ It also mandates gambling disorders be accounted for in research, surveys, existing mental health, and substance use disorder programs offered to members of the armed forces.

Though including gambling screening components in surveys appears to be justified, gaps in this practice have been noted in both active duty and veteran populations.¹¹ Segura et al. (2023) proposed that screening sub-groups with higher prevalence rates may be more feasible and practical than universal screening, especially given the relatively low incidence of gambling disorder occurrence.¹² Sub-group characteristics associated with heightened vulnerabilities  and linked to problematic gambling include service members in the 18-24 year age group, with 0-4 years of military service, and most often serving as a non-commissioned officer/other.² Although definitions of the severity of gambling problems can vary widely, research generally shows connections between compulsive gambling and mental health concerns and well-being that might point to sub-group indicators. Individuals with problematic gambling, for example, have been found to have numerous psychiatric comorbidity indicators, including histories of substance misuse or mental health problems, and may struggle with a constellation of other concerns, including depression, harmful drinking, PTSD, and suicidal ideation.^2,7

Gambling risk-taking also appears to be associated with other categories of risk behaviors. A systematic review exploring the prevalence of gambling harm for active duty service members noted a relationship between health risk behaviors (e.g., reckless driving, physical fighting, drinking, smoking) and gambling disorder.¹³ The association between at-risk/problematic gambling and the greater odds of suicidal ideation, planning, and/or attempts for active duty service members and veterans is noteworthy.^{7, 14}  A bidirectional interaction of vulnerabilities could be at play, whereby mental health issues negatively influence gambling problems and vice versa.

As the military health system makes strides in refining screening practices, it should be noted that some service members fear that disclosures about excessive gambling may compromise security clearances, and/or promotions, and may inhibit disclosure.^7,12,13 Efforts to identify gambling disorder in the context of existing behavioral health services, however, may be more productive. In this situation, trust that has already been established with a provider may lay the groundwork for the honest disclosure necessary for connecting service members to needed help.

 A review of five meta-analytic studies examining 56 unique studies and 5,389 participants found strong empirical support for CBT as an effective treatment strategy to reduce gambling behavior frequency, intensity, and disorder severity.¹⁵ Targeting cognitive distortions and misperceptions, including the illusion of control and loss chasing, as well as behavioral patterns related to responding to cuing and risk-taking habits, are at the heart of effective CBT treatment. Evidence supporting drug therapy (medium beneficial effects for opioid analgesics and atypical antipsychotics) and its impact on gambling symptom severity highlights the value of considering pharmacological treatment options as well, where indicated.¹⁶

Treatment referrals and resources can be found through state and national referral sites, including Substance Abuse and Mental Health Services Administration’s National Helpline: Free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders: 800-662-HELP (4357).

References

1. Stefanovics, E. A., Potenza, M. N., Tsai, J., & Piertzak, R. H. (2022). Prevalence and clinical characteristics of recreational and at-risk/problematic gambling in a national sample of U.S. military veterans. Journal of Gambling Studies, 39, 1077-1097.
2. Cowlishaw, S., Metcalf, O., Lawrence-Wood, E., Little, J., Sbisa, A., Deans, C., O’Donnell, Sadler, N., van Hooff, M., Crozier, M., Battersby, M., Forbers, D., & McFarlane, A. C. (2020). Gambling problems among military personnel after deployment. Journal of Psychiatric Research, 131, 47-53.
3. Mora-Salgueiro, J., García-Estela, A., Hogg, B., Angarita-Osorio, N., Amann, B. L., Carlbring, P., Jimenez-Murcia, S., Perez-Sola, V., & Colom, F. (2021). The Prevalence and clinical and sociodemographic factors of problem online gambling: A systematic review. Journal of Gambling Studies, 37, 899–926. https://doi.org/10.1007/s10899-021-09999-w
4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
5. Hing, N., Smith, M., Rockloff, M., Thorne, H., Russell, A.M., Dowling, N. A., & Breen, H. (2022). How structural changes in online gambling are shaping the contemporary experiences and behaviors of online gamblers: an interview study. BMC Public Health, 22, 1620.
6. Garvey Wilson, A. G., O-Gallagher, K. G., Liu, X., Greenberg, J. G., Otto, J. L., Campbell, M. S., Belsher, B. E., & Evatt, D. P. (2021). Demographic, behavioral, and proximal risk factors for gambling disorder in the US Military. American Journal on Addictions, 30(4), 334-342.
7. van der Maas, M., & Nower, L. (2021). Gambling and military service: Characteristics, comorbidity, and problem severity in an epidemiological sample. Addictive Behaviors, 114, 106725.
8. Gallaway, M. S., Fink, D. S., Sampson, L., Cohen, G. H., Tamburrino, M., Liberzon, I., Calabrese, J., & Galea, S. (2019). Prevalence and covariates of problematic gambling among a US military cohort. Addict Behaviors, 95, 166-171. doi: 10.1016/j.addbeh.2019.03.013. Epub 2019 Mar 21. PMID: 30928661; PMCID: PMC6574081.
9. Gambling Addiction Prevention Act of 2019, S 2060, 116^th Cong. (2019). https://www.congress.gov/bill/116th-congress/house-bill/3658
10. U.S. Government Accountability Office. (Jan. 30, 2017). DOD and the Coast Guard Need to Screen for Gambling Disorder Addiction and Update Guidance (GAO-17-114).  https://www.gao.gov/products/GAO-17-114
11. Etuk, R., Shirk, S. D., Grubbs, J., & Kraus, S. W. (2020). Gambling problems in US military veterans. Current Addiction Reports, 7, 210-228
12. Segura, A., Heyman, R. E., Ochshorn, J., & Smith Slep, A. M. (2023). A Meta-Review to Guide Military Screening and Treatment of Gambling Problems, Military Medicine, 189 (5-6,) 1362–1373, https://doi.org/10.1093/milmed/usad426
13. Paterson, M., Whitty, M., & Leslie, P. (2021). Exploring the prevalence of gambling harm among active duty military personnel: A systematic scoping review. Journal of gambling studies, 37(2), 529–549. https://doi.org/10.1007/s10899-020-09951-4
14. Metcalf, O., Roebuck, G., Lawrence-Wood, E., Sadler, N., Baur, J., Van Hooff, M., Forbes, D., O'Donnell, M., Hodson, S., Benassi, H., Varker, T., Battersby, M., McFarlane, A. C., & Cowlishaw, S. (2023). Gambling problems predict suicidality in recently transitioned military veterans. Australian and New Zealand journal of public health, 47(3), 100038. https://doi.org/10.1016/j.anzjph.2023.100038
15. Pfund, R. A., Ginley, M. K., Kim, H. S., Boness, C. L., Horn, T. L., & Whelan, J. P. (2023). Cognitive-behavioral treatment for gambling harm: Umbrella review and meta-analysis. Clinical psychology review, 105, 102336. https://doi.org/10.1016/j.cpr.2023.102336
16. Dowling, N., Merkouris, S., Lubman, D., Thomas, S., Bowden-Jones, H., & Cowlishaw, S. (2022). Pharmacological interventions for the treatment of disordered and problem gambling. Cochrane Database of Systematic Reviews, 9, Art. No.: CD008936. doi: 10.1002/14651858.CD008936.pub2. Accessed 25 October 2024.

Virginia M. DeRoma, Ph.D. is a subject matter expert who provides contract support to the Psychological Health Center of Excellence in implementation science. She has prior experience as the director of intensive outpatient and day treatment addiction services.

Dan P. Evatt, Ph.D. is the Branch Chief for Research Execution at the Psychological Health Center of Excellence. He has research and clinical expertise in military psychological health, including in the area of addictive behaviors.